Detection and treatment of spinal CSF leaks in idiopathic intracranial hypotension

Abstract

CT and MRI myelography allow the reliable detection of spinal CSF leaks. The targeted and eventually repeated epidural BP procedure is a safe and efficacious treatment.

MR Myelography for Identification of Spinal CSF Leak in Spontaneous Intracranial Hypotension

“…8 Recent literature has questioned whether CTM is the most sensitive technique for the detection and localization of CSF leaks. 9,10 More recent techniques have been described, including dynamic CTM, digital subtraction myelography, heavily T2-weighted spinal MR imaging, and intrathecal gadolinium MR myelography (MRM). Both dynamic CT and digital subtraction myelography have been advocated in cases with significant spinal extra-arachnoid fluid collections on preprocedural spinal MR imaging.…”

Liquorverlustsyndrom

“…2). Nicht selten weisen die Patienten 2 oder auch mehrere Liquorlecks auf [1,11]. Neben dem primären Einriss der Dura sind es häu-fig zystisch erweiterte Wurzeltaschen, die sich als Locus minoris resistentiae erweisen und zum Liquorleck führen.…”

“…Manche Autoren propagieren die MRMyelographie nach intrathekaler Gadolinium(Gd)-Gabe als vielversprechende Alternative und verwenden sie teilweise sogar für Follow-up-Untersuchungen nach durchgeführtem "blood patch" [1,25]. Tatsächlich zeigte die MR-Myelographie in den vorliegenden Publikationen im Vergleich zur CT-Myelographie aufgrund der höheren Ortsauflösung eine höhere Sensitivität beim Nachweis und der Lokalisierung der Liquorlecks.…”

Apparent diffusion coefficient measurements to support a diagnosis of intracranial hypotension

“…7 To further the diagnostic complexity, CSF opening pressures are not always obtained or may not be completely reliable in ICH patients, and blood patch may not be successful, particularly if the sight of leak is not known, and multiple blood patches may be needed to achieve relief from symptoms. 16,18 A recent study reports high success with identification of CSF leaks with MR contrast myelography, 19 but MR contrast is not currently approved by the federal food and Drug Administration for intrathecal administration in the USA, and most facilities hesitate to use MR contrast for this purpose. Myelography, CSF pressure studies and blood patch are invasive procedures that should ideally be reserved for treatment rather than diagnostic purposes.…”

“…37-year-old man with headache following intrathecal chemotherapy. Here the meningial enhancement (right) may be due to chemotherapy [19], and this patient is therefore not included in the intracranial hypotension group. Thin bilateral subdural collections and average diffusion constant of 763 suggest hypotension, likely secondary to lumbar puncture.…”